Disease List

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                            "name": "отравление"
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            "etiology": "<p>У новорождённого развитие омфалита чаще всего происходит из-за попадания инфекции в незажившую пупочную рану. Это может произойти при перевязке пуповины или несоблюдении правил при обработке пупка мамой в период новорождённости. Также некоторые внешние факторы могут провоцировать возникновение омфалита у новорождённого:  </p>\r\n<ul>\r\n<li>Наличие внутриутробной инфекции в детском организме; </li>\r\n<li>Нарушение правил гигиены при уходе за заживающей пупочной раной; </li>\r\n<li>Неправильная обработка, использование запрещённых средств, купание в загрязнённой воде;  </li>\r\n<li>Применение необработанных и непродезинфицированных предметов ухода; </li>\r\n<li>Новорожденные с гипоксией и аномалиями развития, в первую очередь это аномалии самого пупка; </li>\r\n<li>Наличии пеленочного дерматита или других инфекционных заболеваний кожи у новорожденного (пиодермии, фолликулита). </li>\r\n</ul>\r\n<p>Возбудителями омфалита чаще всего оказываются стафилококки, стрептококки, примерно в 30% случаев - грамотрицательные микроорганизмы (кишечная палочка, клебсиелла и др.). </p>",
            "pathogenesis": "<p>По причинам возникновения омфалит может быть первичным (при инфицировании пупочной ранки) или вторичным (в случае присоединения инфекции на фоне имеющихся врожденных аномалий - свищей). Вторичный омфалит у ребенка развивается в более поздние сроки и протекает более длительно. </p>\r\n<p>По характеру и степени воспалительных изменений в области пупка различают катаральный или простой омфалит («мокнущий пупок»), флегмонозный и гангренозный (некротический) омфалит  </p>\r\n<p>Возбудитель (преимущественно стафилококк) проникает в ткани, прилежащие к пупку, через культю пуповины или через ранку после её отпадения. Инфекция может распространяться и фиксироваться в пупочных сосудах (чаще в артериях, реже в венах), вызывая продуктивное, гнойное или некротическое воспаление. Распространение воспаления приводит к развитию флегмоны в области пупка. При вовлечении в процесс пупочной вены возникает флебит (воспаление стенки сосуда), который может распространиться по воротной вене во внутрипечёночные её разветвления. Нередко при этом по ходу вен образуются гнойные очаги, иногда уже после заживления пупочной раны </p>",
            "diagnostics": "<p>Диагностика заболевания не представляет трудностей и основывается на характерных местных признаках заболевания (наличие отделяемого из пупочной ранки, покраснение кожи вокруг нее). </p>\r\n<p>При развитии гнойной, флегмонозной или некротической форм возможны воспалительные изменения в общем анализе крови (повышение уровня лейкоцитов и СОЭ). </p>\r\n<p>При неэффективности назначенного лечения проводится исследование – посев отделяемого из пупка с определением чувствительности микроорганизмов к антибиотикам (в зависимости от его результатов подбирается другой антибиотик). </p>\r\n<p>Дополнительные исследования проводятся при возникновении осложнений: </p>\r\n<ul>\r\n<li>УЗИ брюшной полости (при подозрении на перитонит (воспаление брюшной полости)); </li>\r\n<li>УЗИ мягких тканей (при подозрении на флегмону брюшной стенки – гнойное воспаление подкожной клетчатки). </li>\r\n</ul>",
            "treatment": "<p> Местное лечение:  </p>\r\n<ul>\r\n<li>Удаление пупочного отделяемого и обработки пупочной ранки антисептическими растворами (перекисью водорода, бриллиантовым зеленым); </li>\r\n<li>в случае гнойной формы местно назначаются антибактериальные мази, а также применяется дренирование раны (установка в рану специальной трубки для оттока гноя наружу с ее помощью); </li>\r\n<li>иссечение некротизированных тканей; </li>\r\n<li>применяется также физиолечение (УФО – ультрафиолетовое облучение, УВЧ – ультравысокочастоная терапия). </li>\r\n</ul>\r\n<p>Системное лечение: </p>\r\n<ul>\r\n<li>антибиотики широкого спектра действия с учетом чувствительности флоры; </li>\r\n<li>витаминотерапия; </li>\r\n<li>дезинтоксикационная терапия; </li>\r\n<li>средства, повышающие иммунитет. </li>\r\n</ul>",
            "prevention": "<p>Профилактика омфалита предполагает соблюдение асептики при обработке пуповины, ежедневном уходе за пупочной ранкой, соблюдение гигиены ухаживающим персоналом. Категорически недопустимо насильственно срывать корочки с пупочной ранки, закрывать ее повязкой или подгузником, заклеивать лейкопластырем, поскольку это провоцирует мокнутие и инфицирование. В случае покраснения пупочной ранки, появления отечности и отделяемого следует незамедлительно проконсультироваться у педиатра. <br class=\"SCXW172751371\" /> </p>",
            "clinical_picture": "<p>При катаральном омфалите пупочная ранка не затягивается, из нее начинает выделяться скудный секрет серозного (прозрачного), кровянистого или серозно-гнойного характера. Ранка периодически затягивается корочками, однако после их отторжения дефект не эпителизируется. Пупочное кольцо гиперемировано (красное) и отечно. При длительном мокнутии (в течение 2-х и более недель) может происходить избыточное разрастание молодой соединительной ткани (грануляций) с формированием на дне пупочной ранки грибовидного выпячивания – фунгуса пупка, который еще более затрудняет заживление. Общее состояние новорожденного (аппетит, физиологические отправления, сон, прибавка в массе) при простой форме омфалита обычно не нарушено; иногда отмечается небольшое повышение температуры. </p>\r\n<p>Флегмонозный омфалит характеризуется распространением воспаления на окружающие ткани и обычно является продолжением «мокнущего пупка». Кожа вокруг пупка гиперемирована, подкожная клетчатка отечна и возвышается над поверхностью живота. Рисунок венозной сети на передней брюшной стенке усилен, наличие красных полос свидетельствует о присоединении воспаления лимфатических сосудов. </p>\r\n<p>Кроме мокнутия пупочной ранки, отмечается пиорея – истечение гнойного отделяемого и выделение гноя при надавливании на околопу­почную область. Возможно образование на дне пупочной ямки язвочки, покрытой гнойным налетом. При флегмонозном омфалите состояние младенца ухудшается: температура тела повышается до 38°С, выражены признаки интоксикации (вялость, плохой аппетит, срыгивания, диспепсия), замедляется нарастание массы тела. У недоношенных детей локальные изменения при омфалите могут быть выражены минимально, зато на первый план обычно выходят общие проявления, молниеносно развиваются осложнения. </p>\r\n<p>Некротический омфалит встречается редко, обычно у ослабленных детей (с иммунодефицитом, гипотрофией и т.д.). При этом расплавление клетчатки распространяется в глубину. В области пупка кожа приобретает темно-багровый, синюшный оттенок. При некротическом омфалите воспаление практически всегда переходит на пупочные сосуды. В некоторых случаях могут некротизироваться все слои передней брюшной стенки с развитием контактного перитонита. Гангренозный омфалит имеет наиболее тяжелое течение: температура тела может снижаться до 36°С, ребенок истощен, заторможен, не реагирует на окружающие раздражители. </p>\r\n<p> </p>",
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            },
            "code": "A16",
            "name": "Туберкулез органов дыхания, не подтвержденный бактериологически или гистологически",
            "icd_name": "Туберкулез органов дыхания, не подтвержденный бактериологически или гистологически",
            "gender": 0,
            "age_min": 0,
            "age_max": 100,
            "cause": [
                3,
                2,
                4,
                5
            ],
            "periodicity": 1,
            "slug": "a16_tuberkulez_organov_dyhaniya_ne_podtverzhdennyy_bakteriologicheski_ili_gistologicheski",
            "lead": "Нарушение здоровья, относящееся к группе туберкулез",
            "description": "Инфекционное, высококонтагиозное заболевание,при котором в органах дыхания образуются очаги специфического воспаления.",
            "etiology": "<p>Возбудитель  заболевания - микобактерия туберкулеза. </p>\r\n<p class=\"li\">Роль различных видов микобактерий туберкулеза (МБТ) (или бацилл Коха - БК) в развитии туберкулеза у людей различна:</p>\r\n<ul>\r\n<li>M. tuberculosis humanus вызывает 80-85% всех заболеваний;</li>\r\n<li>M. Tuberculosis bovinus - возбудитель 10-15% всех случаев туберкулеза;</li>\r\n<li>M. Tuberculosis africanus вызывает до 90% всех случаев туберкулеза у жителей Южной Африки;</li>\r\n<li>M. Tuberculosis microti редко вызывает заболевание у человека.</li>\r\n</ul>\r\n<p>Главный  источник заражения - больные люди или домашние животные. Заражаются обычно аэрогенным путем при вдыхании с воздухом выделяемых больными мельчайших капелек мокроты, в которых содержится возбудитель. Кроме того, возможно проникновение в организм инфекции при употреблении молока, мяса, яиц от больных животных и птиц. В этих случаях микробы заносятся в легкие или из глоточных миндалин, или по лимфатическим и кровеносным путям из кишечника. У подавляющего большинства впервые заболевших в мокроте обнаруживают микобактерии туберкулеза, чувствительные, а у 5 - 10% - устойчивые к различным противотуберкулезным препаратам. В последнем случае заражение происходит от больных, которые неэффективно лечатся специфическими медикаментами и выделяют устойчивые штаммы возбудителя. При специальном исследовании в мокроте и в органах больных иногда удается обнаружить L - формы микобактерий, отличающиеся сравнительно небольшой вирулентностью и патогенностью, но способные при определенных условиях превращаться в типичную микробную форму.</p>",
            "pathogenesis": "<p>Впервые проникшие в организм микобактерии туберкулеза распространяются в нем различными путями - лимфогенным, гематогенным, бронхолегочным. При этом в различных органах, главным образом в лимфатических узлах и легких, могут образоваться отдельные или множественные туберкулезные бугорки или более крупные очаги, для которых характерно наличие эпителиоидных и гигантских клеток, а также элементов творожистого некроза. Одновременно появляется положительная реакция на туберкулин, так называемый туберкулиновый вираж, устанавливаемый по внутрикожной пробе Манту.</p>",
            "diagnostics": "<p>Диагноз и рекомендуемые клинические исследования</p>\r\n<p class=\"li\">Обязательный диагностический минимум:</p>\r\n<ul>\r\n<li>изучение истории заболевания и жалоб пациентов;</li>\r\n<li>врачебный осмотр;</li>\r\n<li>клинический анализ крови и мочи;</li>\r\n<li>трехкратное микроскопическое исследование мазков мокроты, окрашенных по Цилю - Нильсену;</li>\r\n<li>рентгенография органов грудной клетки в прямой и боковой проекции:</li>\r\n<li>туберкулиновая проба Манту.</li>\r\n</ul>\r\n<p>Дополнительные методы исследования:</p>\r\n<p class=\"li\">Неинвазивные:</p>\r\n<ul>\r\n<li>исследование мокроты на МБТ (ПЦР, посев на питательные среды с определением чувствительности МБТ к противотуберкулезным лекарственным средствам (ЛС);</li>\r\n<li>посев мокроты на неспецифическую микрофлору и грибы;</li>\r\n<li>иммунологические методы для выявления в крови противотуберкулезных антител и антигенов;</li>\r\n<li>компьютерная томография легких, обычная томография и зонография;</li>\r\n<li>ультразвуковое исследование (при плеврите и субплевральных округлых образованиях).</li>\r\n</ul>\r\n<p class=\"li\">Инвазивные (с последующим цитологическим, гистологическим и микробиологическим исследованием полученного материала):</p>\r\n<ul>\r\n<li>бронхоскопия с различными видами биопсии (аспирационной, щеточной и др.) и бронхоальвеолярным лаважем;</li>\r\n<li>пункция плевральной полости и биопсия плевры;</li>\r\n<li>трансторакальная биопсия легкого;</li>\r\n<li>торакоскопия;</li>\r\n<li>медиастиноскопия;</li>\r\n<li>открытая биопсия легкого.</li>\r\n</ul>\r\n<p>Наиболее широко используется для диагностики туберкулеза легких микроскопия мокроты, рентгенография органов грудной клетки и туберкулиновая проба Манту.</p>\r\n<p>Однако, туберкулиновая проба Манту сохранила свое значение у детей и подростков. У взрослых в большинстве случаев она не позволяет отличить состояние инфицированности от болезни.</p>\r\n<p>Компьютерная томография легких часто оказывается более информативной, чем другие методы рентгенологической диагностики туберкулеза легких.</p>\r\n<p>При установлении диагноза туберкулеза методы полимеразной цепной реакции (ПЦР) и определения антител к МБТ в различных биологических субстратах являются дополнительными, их результаты должны сопоставляться с данными других клинических исследований.</p>",
            "treatment": "<p>Лечение туберкулёза легких должно быть непрерывным и обязательно должно проводиться одновременно несколькими противотуберкулёзными препаратами. Каждое из 4-5 лекарств, которые больной принимает ежедневно в течение 6 месяцев, по-разному воздействует на палочки Коха, и только совместное их применение может достичь цели - окончательно ее уничтожить. Для качественного излечения одних противотуберкулёзных лекарств недостаточно. Больным также прописывают физиотерапию, дыхательнаую гимнастику и препараты, поднимающие иммунитет.</p>\r\n<p>Основой лечения туберкулёза сегодня является поликомпонентная противотуберкулёзная химиотерапия (J04 Противотуберкулёзные препараты).</p>\r\n<p>Трёхкомпонентная схема лечения</p>\r\n<p>На заре противотуберкулёзной химиотерапии была выработана и предложена трёхкомпонентная схема терапии первой линии: - стрептомицин - изониазид - пара-аминосалициловая кислота (ПАСК). Эта схема стала классической. Она царствовала во фтизиатрии долгие десятилетия и позволила спасти жизни огромного числа больных туберкулёзом.</p>\r\n<p>Четырёхкомпонентная схема лечения</p>\r\n<p>Одновременно в связи с повышением устойчивости выделяемых от больных штаммов микобактерий возникла необходимость усиления режимов противотуберкулёзной химиотерапии. В результате была выработана четырёхкомпонентная схема химиотерапии первой линии (DOTS - стратегия, используется при инфицировании достаточно чувствительными штаммами): - рифабутин или рифампицин - стрептомицин или канамицин - изониазид или фтивазид - пиразинамид либо этионамид Эта схема была разработана Карелом Стибло (Нидерланды) в 1980-х гг. На сегодняшний день система лечения т. н. препаратами первого ряда (включая изониазид, рифампицин, стрептомицин, пиразинамид и этамбутол) является общепринятой в 120 странах мира, включая развитые страны. В некоторых постсоветских странах (Россия, Украина) ряд специалистов считает данную схему недостаточно эффективной и существенно уступающей по уровню разработанной и внедрённой в СССР комплексной противотуберкулёзной стратегии, опирающейся на развитую сеть противотуберкулёзных диспансеров.</p>\r\n<p>Пятикомпонентная схема лечения</p>\r\n<p>Во многих центрах, специализирующихся на лечении туберкулёза, сегодня предпочитают применять ещё более мощную пятикомпонентную схему, добавляя к упомянутой выше четырёхкомпонентной схеме производное фторхинолона, например, ципрофлоксацин. Включение препаратов второго, третьего и выше поколения является основным при лечении лекарственноустойчивых форм туберкулёза. Режим лечения препаратами второго и выше поколения подразумевает как минимум 20 месяцев ежедневного приёма препаратов. Данный режим гораздо дороже, чем лечение препаратами первого ряда, и составляет эквивалент примерно в 25 000 долларов США на весь курс. Существенно ограничивающим моментом также является наличие огромного количества различного рода побочных эффектов от применения препаратов второго и выше поколения. Если, несмотря на 4-5-компонентный режим химиотерапии, микобактерии всё же развивают устойчивость к одному или нескольким применяемым химиопрепаратам, то применяют химиопрепараты второй линии: циклосерин, капреомицин и др. Кроме химиотерапии, большое внимание должно уделяться интенсивному, качественному и разнообразному питанию больных туберкулёзом, набору массы тела при пониженной массе, коррекции гиповитаминозов, анемии, лейкопении (стимуляции эритро- и лейкопоэза). Больные туберкулёзом, страдающие алкоголизмом или наркотической зависимостью, должны пройти детоксикацию до начала противотуберкулёзной химиотерапии. Больным туберкулёзом, получающим иммуносупрессивные препараты по каким-либо показаниям, стараются снизить их дозы или совсем отменить их, уменьшить степень иммуносупрессии, если это позволяет клиническая ситуация по заболеванию, потребовавшему иммуносупрессивной терапии. Больным ВИЧ-инфекцией и туберкулёзом показана специфическая анти-ВИЧ терапия параллельно с противотуберкулёзной.</p>",
            "prevention": "<p>В целях профилактики необходимо проведение следующих мероприятий:- проведение профилактических и противоэпидемических мероприятий адекватных сложившейся крайне неблагополучной эпидемиологической ситуации по туберкулезу. - раннее выявление больных и выделение средств на лекарственное обеспечение. Это мероприятие сможет также уменьшить заболеваемость людей, вступающих в контакт в очагах с больными. - проведение обязательных предварительных и периодических осмотров при поступлении на работу в животноводческие хозяйства, неблагополучных по заболеванию туберкулезом крупного рогатого скота. - увеличение выделяемой изолированной жилой площади больным, страдающим активным туберкулезом и проживающим в многонаселенных квартирах и общежитиях. - своевременнее проведение (до 30 дней жизни) первичной вакцинации новорожденным детям.</p>",
            "clinical_picture": "<p>Обычно симптоматика заболевания скрыта, но может наблюдаться острое начало</p>\r\n<p>Для туберкулеза органов дыхания (ТОД) характерно волнообразное течение с периодами обострения и затихания процесса.</p>\r\n<p>Наиболее выражены клинические проявления у больных с деструктивными и распространенными формами туберкулеза.</p>\r\n<p class=\"li\">Симптомы, обусловленные поражением органов дыхания:</p>\r\n<ul>\r\n<li>кашель с мокротой;</li>\r\n<li>боль в грудной клетке;</li>\r\n<li>кровохаркание и легочное кровотечение;</li>\r\n<li>одышка.</li>\r\n</ul>\r\n<p class=\"li\">Симптомы интоксикации:</p>\r\n<ul>\r\n<li>повышение температуры тела (у 40-80% пациентов);</li>\r\n<li>тахикардия;</li>\r\n<li>потливость (особенно ночью);</li>\r\n<li>ознобы;</li>\r\n<li>повышенная утомляемость;</li>\r\n<li>слабость;</li>\r\n<li>снижение или отсутствие аппетита;</li>\r\n<li>уменьшение веса тела;</li>\r\n<li>депрессия или гипоманиакальные состояния.</li>\r\n</ul>\r\n<p>.</p>\r\n<p> </p>",
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